摘要
目的探讨重症胰腺炎(SAP)患者血清脂肪因子趋化素水平改变与临床预后的相关性。方法纳入40例SAP患者,根据28d死亡情况分为死亡组(16例)和存活组(24例)。所有患者分别于入重症监护病房(ICU)当天(T0)和第7天(T1)检测血常规、C反应蛋白(CRP)、趋化素、白细胞介素(IL)-1β和肿瘤坏死因子α(TNF-α)水平。结果死亡组患者T1时WBC、CRP、IL-1β、TNF-α和趋化素水平明显升高,差异有统计学意义(P<0.05);而存活组患者IL-1β、TNF-α和趋化素水平明显升高,差异有统计学意义(P<0.05),其他指标比较差异无统计学意义(P>0.05)。T1时,存活组患者WBC、CRP、IL-1β、TNF-α和趋化素水平低于死亡组患者,其中WBC、CRP、TNF-α和趋化素差异有统计学意义(P<0.05)。Δ趋化素(T1与T0时趋化素的变化值)的曲线下面积(AUC)为0.837,95%CI为0.772~0.889,cut-off值为11.6mg/L,敏感性为82.3%,特异性为85.4%。趋化素(T1时的趋化素水平和Δ趋化素)与28d死亡风险呈正相关(r分别为0.599、0.664,P<0.05)。Δ趋化素与ΔIL-1β(T1与T0时IL-1β的变化值)呈正相关(r=0.554,P<0.05)、Δ趋化素与ΔTNF-α(T1与T0时TNF-α的变化值)呈正相关(r=0.585,P<0.05)。T1时的趋化素水平(>25.5mg/L,OR=1.310,95%CI0.910~2.540,P<0.05)和Δ趋化素(>11.6mg/L,OR=1.890,95%CI0.940~2.820,P<0.05)为SAP患者28d死亡事件发生的独立危险因素。结论 SAP患者血清趋化素水平明显升高,可以作为死亡风险的预警指标。
Objective To investigate the correlation between serum adipocytokine chemerin level and clinical prognosis in the patients with severe acute pancreatitis（SAP）. Methods Forty SAP patients were divided into two group based on 28-day mortality： death group（n= 16） and survival group（n = 24）. The blood routine and levels of CRP, chemerin, IL-1β and TNF-α were measured at admission to ICU（T0） and on 7 d after admission（T1）. Results The levels of WBC,CRP,IL-1β,TNF-α and chemerin in the death group were significantly increased on 7 d after admission to ICU, the differences were statistically significant（P〈0.05）, while only IL-1β,TNF-α and chemerin levels in the survival group were elevated, the differences were statistically significant（P〈0.05）, but the comparison of other indexes had no statistical difference（P〈0.05）. The levels of WBC,CRP,IL-1β,TNF-α and chemerin at T1 in the survival group were lower than those in the death group, in which the differences in WBC, CRP, TNF-α and chemerin had statistical significance（P〈0.05）. The area under the curve（AUC） of △chemerin（chemerin change value at T1 and T0） was 0. 837, 95%CI was 0. 772-0. 889,the cut-off value was 11.6 mg/L,the sensitivity and specificity were 82.3% and 85.4% respectively. Chemerin（chemerin level at T1 and Achemerin） was positively correlated with the death risk on 28 d（r= 0. 599,0. 664,P〈0.05）. △chemerin was positively correlated with △IL-1β（IL- 1β change value at T1 and T0）（r= 0.554, P〈0.05）, △chemerin was positively correlated with △TNF-α（TNF -α change value at T1 and T0）（r= 0. 585, P〈0.05）. The chemerin level at T1 （〉 25.5 mg/L,OR = 1.310,95% CI 0.910-2. 540, P〈0.05） and △chemerin were the independent risk factors of 28 d death event occurrence in SAP patients. Conclusion The serum chemerin level in SAP patients is significantly increased and can serve as a forewarning index of death risk.
出处
《检验医学与临床》
CAS
2017年第6期808-810,813,共4页
Laboratory Medicine and Clinic
关键词
重症胰腺炎
趋化素
临床预后
预警
severe acute pancreatitis
chemerin
clinical prognosis
forewarning
